The NHS has announced a new five-year strategy for healthcare in southwest London following the scrapping of the Better Services Better Value (BSBV) review.

A draft of the new programme, called South West London Collaborative Commissioning (SWLCC), was published this morning by Croydon, Kingston, Merton, Richmond, Sutton and Wandsworth Clinical Commissioning Groups (CCGs).

The strategy, which aims to limit the spiralling costs of healthcare while improving the quality of care, will be discussed for approval at public meetings held by each of the CCG's governing bodies over the next few weeks.

If approved, the details of its implementation will be debated by the CCGs with healthcare trusts and health and wellbeing boards, including the role of each local trust in delivering the strategy.

SWLCC replaces BSBV, a review aiming to reconfigure services across St Helier, Kingston, Croydon and St George's hospitals, which was scrapped in February.

Epsom Hospital, which had been part of the review since late 2012, left BSBV in November last year after the area's GPs, sitting on Surrey Downs CCG, voted to reject its proposals.

Under BSBV's plans, both Epsom and St Helier hospitals would have lost their A&E, and maternity departments as well as their children's departments, which Croydon hospital would also have lost.

A SWLCC spokesman said the new strategy has been designed to meet a number of clinical and financial challenges facing the NHS nationally - including a rising demand for healthcare; a shortage of specialist staff; and a predicted shortfall of £210m in the six CCGs' budgets over the next five years.

In addition to this shortfall, a spokesman said that Epsom and St Helier, Croydon, Kingston and St George's NHS trusts have to identify an additional £360m worth of savings over the same period.

The spokesman said that SWLCC aims to meet 100 per cent of the London Quality Standards by 2018-19 - standards setting out what good care should look like, developed by clinicians and patients.

He said the strategy aims to ensure that seven-day services are delivered by 2015-16, that networks of GPs are developed, that standards of community-based services are raised, and that most planned operations in South West London requiring an overnight stay will take place in a planned care centre within five years.

In contrast to BSBV, SWLCC also aims to reshape mental health services because "mental health services often fail to provide support at an early enough stage, leading to service users becoming more seriously unwell and having to be admitted to a mental health hospital".

Dr Howard Freeman, chairman of Merton CCG and the SWLCC strategic commissioning board, said: "The CCGs have been working together and talking to local clinicians during our first year, to work out the best ways of tackling the clinical and financial problems that we have inherited.

"Everyone working in the NHS knows that things need to change and the challenge will only get tougher in the years ahead.

"The reality is that we face a stark choice between change planned and agreed by local clinicians or some services becoming clinically and financially unsustainable - which will ultimately lead to changes over which we have no control.

"We can only address this by working together - the good news is that if we address it in the right way, we can significantly improve services and outcomes for our patients.

"This is a high level strategy, which sets out the standards that we as commissioners expect for our patients.

"Central to the strategy is the need to change the way we deliver health services to meet the changing needs of our population.

"This means we need to spend more money on services based in the community, keeping people out of hospital unless they really need to be there.

"The NHS has been talking to local people about the challenges we face for the last three years and recently held further meetings as part of the national Call to Action initiative.

"All of the concerns and points that people have raised with us have been taken into consideration and that will continue during the implementation phase.

"The one thing we really cannot do is to opt out of the challenges we face.

"Things do need to change if we are to provide safe, high quality and sustainable services across south west London."

Every single quote in this article is in turgid management speak. Lots of words have been puked out by Dr Howard Freeman in some sort of reasonably comprehensible order but he has not actually said anything.

Every single quote in this article is in turgid management speak. Lots of words have been puked out by Dr Howard Freeman in some sort of reasonably comprehensible order but he has not actually said anything.Georgia Lewis

I quote: "either we can oversee a continuous decline in our local health
system followed by organisational failure and a need for external intervention, or we work with clinical colleagues and local people to agree a planned set of changes that deliver the care that our
residents deserve within the funding available to us in south west London. As the custodians of the health system, and as local GPs, we believe the latter is the only acceptable way forward."

So that effectively means that people will get the care that the budgets allow, not the care that is needed? Where do these 'custodians' state that they will fight for proper funding that allows the same level of care to be accessible for all?

I quote: "either we can oversee a continuous decline in our local health
system followed by organisational failure and a need for external intervention, or we work with clinical colleagues and local people to agree a planned set of changes that deliver the care that our
residents deserve within the funding available to us in south west London. As the custodians of the health system, and as local GPs, we believe the latter is the only acceptable way forward."
So that effectively means that people will get the care that the budgets allow, not the care that is needed? Where do these 'custodians' state that they will fight for proper funding that allows the same level of care to be accessible for all?Niki R

What a coincidence that these have been released JUST AFTER the local elections.

And another document here:
http://www.swlccgs.n
hs.uk/wp-content/upl
oads/2014/05/Executi
ve-Summary-Draft-Pla
n1.pdf
What a coincidence that these have been released JUST AFTER the local elections.Forty_two

Forty_two wrote:
Hardly easy to find this, but here's a link to the document in question:
https://s3-eu-west-1

.amazonaws.com/s3.he

lpfulclients.com/swl

ccgs/SWLCC+draft+5+y

ear+strategic+plan.p

df

Thanks for this – very interesting.

The first (syntax-challenged) significant phrase I note is this:

“The strategic plan does not include any detail of the range of interventions taking place in each borough, for this information please consult each CCG’s individual plans, however the themes align closely across all six boroughs.”

But the individual plans aren’t listed here.

Secondly, on page 78, only the Sutton section (out of six boroughs) refers to any reduction in A&E use:

“Establish an integrated community health and social care service aimed at reducing demand for care home, hospital and A&E.”

In other words, this seems to be the same plan as before, dressed up as something else but being delivered by the same people – and this phrase to me suggests a running down of hospital and A&E services in Sutton, ie. the partial closure of St Helier Hospital.

It will be interesting to see other people’s interpretations of this woolly document. Wonder how long it will be before Messrs Brake and Burstow have an opinion?

[quote][p][bold]Forty_two[/bold] wrote:
Hardly easy to find this, but here's a link to the document in question:
https://s3-eu-west-1
.amazonaws.com/s3.he
lpfulclients.com/swl
ccgs/SWLCC+draft+5+y
ear+strategic+plan.p
df[/p][/quote]Thanks for this – very interesting.
The first (syntax-challenged) significant phrase I note is this:
“The strategic plan does not include any detail of the range of interventions taking place in each borough, for this information please consult each CCG’s individual plans, however the themes align closely across all six boroughs.”
But the individual plans aren’t listed here.
Secondly, on page 78, only the Sutton section (out of six boroughs) refers to any reduction in A&E use:
“Establish an integrated community health and social care service aimed at reducing demand for care home, hospital and A&E.”
In other words, this seems to be the same plan as before, dressed up as something else but being delivered by the same people – and this phrase to me suggests a running down of hospital and A&E services in Sutton, ie. the partial closure of St Helier Hospital.
It will be interesting to see other people’s interpretations of this woolly document. Wonder how long it will be before Messrs Brake and Burstow have an opinion?David7

Why are these GPs not joining us to fight for full and proper funding ot essential healthcare services? Why are they allowing these budget cuts to be imposed without so much as a whimper?

This too is worrying:

"Mental health. We will commission a series of initiatives to develop capacity in community services, including developing a single point of access, increased access to psychological therapies and greater provision of home treatment, to be implemented between 2014/15
and 2016/17, with a view to providing better care and reducing acute in-patient admissions from 2017/18." Effectvely in patient care will be reduced, meaning more of the most vulnerable people with mental health issues will be left to their own devices in the community with occasional 'at home' therapy.

Also:

"Further improvements in efficiency and effectiveness, including greater connectivity with other settings, to be pursued through implementation of new IT systems."

Yes, we all know how brilliant NHS IT systems are at improving efficiency!

Most of all, what does 'consolidation' of childrens' services mean for Queen Mary's?

Why are these GPs not joining us to fight for full and proper funding ot essential healthcare services? Why are they allowing these budget cuts to be imposed without so much as a whimper?
This too is worrying:
"Mental health. We will commission a series of initiatives to develop capacity in community services, including developing a single point of access, increased access to psychological therapies and greater provision of home treatment, to be implemented between 2014/15
and 2016/17, with a view to providing better care and reducing acute in-patient admissions from 2017/18." Effectvely in patient care will be reduced, meaning more of the most vulnerable people with mental health issues will be left to their own devices in the community with occasional 'at home' therapy.
Also:
"Further improvements in efficiency and effectiveness, including greater connectivity with other settings, to be pursued through implementation of new IT systems."
Yes, we all know how brilliant NHS IT systems are at improving efficiency!
Most of all, what does 'consolidation' of childrens' services mean for Queen Mary's?Niki R

Forty_two wrote:
A link to the document this article refers to might have been a good idea Guardian?

Yes of course - we have now added a link to the document within the story.

Thanks very much!

Omar Oakes
Digital Editor

[quote][p][bold]Forty_two[/bold] wrote:
A link to the document this article refers to might have been a good idea Guardian?[/p][/quote]Yes of course - we have now added a link to the document within the story.
Thanks very much!
Omar Oakes
Digital Editorooakes

And the document released today has a strong focus on consultant-led care. However, we have already been told when BSBV was still alive and kicking that there are not enough consultants available at the moment and not enough consultants in training in the UK either. Does this mean there are plans to hire more consultants from other countries? How else could the 24-hour consultant care standard for A&E be met or the 14-hour consultant care standard for maternity be met? And how does this fit in with the plan to save £360m?

And the document released today has a strong focus on consultant-led care. However, we have already been told when BSBV was still alive and kicking that there are not enough consultants available at the moment and not enough consultants in training in the UK either. Does this mean there are plans to hire more consultants from other countries? How else could the 24-hour consultant care standard for A&E be met or the 14-hour consultant care standard for maternity be met? And how does this fit in with the plan to save £360m?Georgia Lewis

Georgia Lewis wrote:
And the document released today has a strong focus on consultant-led care. However, we have already been told when BSBV was still alive and kicking that there are not enough consultants available at the moment and not enough consultants in training in the UK either. Does this mean there are plans to hire more consultants from other countries? How else could the 24-hour consultant care standard for A&amp;E be met or the 14-hour consultant care standard for maternity be met? And how does this fit in with the plan to save £360m?

It can be met by implementing the recommendations of BSBV!

Don’t be fooled – the subtext of that document is clear. This is BSBV under another name, with a different presentation.

[quote][p][bold]Georgia Lewis[/bold] wrote:
And the document released today has a strong focus on consultant-led care. However, we have already been told when BSBV was still alive and kicking that there are not enough consultants available at the moment and not enough consultants in training in the UK either. Does this mean there are plans to hire more consultants from other countries? How else could the 24-hour consultant care standard for A&E be met or the 14-hour consultant care standard for maternity be met? And how does this fit in with the plan to save £360m?[/p][/quote]It can be met by implementing the recommendations of BSBV!
Don’t be fooled – the subtext of that document is clear. This is BSBV under another name, with a different presentation.David7

It seems to me that the NHS has just set out again what the problems are, which anyone not living in a cave should know by now. They've set what standards they'd like to meet in future, but now how they will meet them.

I for one just wish they would get on with making the changes we know are needed. The changes made to stroke services in London serve as a great example to follow. Yes it will mean providing some key services on fewer sites, but those services are currently being provided by under-qualified staff much of the time and it's costing hundreds of lives. The doctors just need to show a bit of courage and bring forward proposals to address the problem. No more time-wasting. As with stroke, some people will never agree, but they were proved wrong then and they will be proved wrong again. Get on with it!

It seems to me that the NHS has just set out again what the problems are, which anyone not living in a cave should know by now. They've set what standards they'd like to meet in future, but now how they will meet them.
I for one just wish they would get on with making the changes we know are needed. The changes made to stroke services in London serve as a great example to follow. Yes it will mean providing some key services on fewer sites, but those services are currently being provided by under-qualified staff much of the time and it's costing hundreds of lives. The doctors just need to show a bit of courage and bring forward proposals to address the problem. No more time-wasting. As with stroke, some people will never agree, but they were proved wrong then and they will be proved wrong again. Get on with it!Danny Bhoy

Danny Bhoy, it is indeed true that specialist stroke and cardiac units have saved lives. Fabrice Muamba is a great example of this. But this does not mean that cutting entire A&E departments or reducing them to "Urgent Care Centre" status (whereby they are only obliged to be open 12 hours a day) - as proposed in the BSBV plan and what we are expecting to see as a result of the latest "strategy" - is a step in the right direction.

A&E departments see plenty of cases every day that do require urgent treatment but are not strokes or heart attacks. St Georges A&E at Tooting is already at full capacity and it relies on St Helier as a place to send ambulances when they cannot cope.

There have been promises of more money spent to increase capacity at St Georges but this seems to be at odds with the plan to save money and anyone who has been to that hospital can see that space is tight and parking is already a nightmare. What are they going to do? Knock down nearby houses? Another PFI project perhaps?

Also, the bureaucrats' obsession with providing consultant-based care 24/7 as per the quality standards is absurd when there are not enough consultants in the UK or in training in the UK to meet this requirement. Therefore, we will need to spend money bringing in doctors from other countries as well as more investment in training medical students in the unpopular specialty of A&E to meet this standard but that also flies in the face of the drive to cut costs.

Danny Bhoy, it is indeed true that specialist stroke and cardiac units have saved lives. Fabrice Muamba is a great example of this. But this does not mean that cutting entire A&E departments or reducing them to "Urgent Care Centre" status (whereby they are only obliged to be open 12 hours a day) - as proposed in the BSBV plan and what we are expecting to see as a result of the latest "strategy" - is a step in the right direction.
A&E departments see plenty of cases every day that do require urgent treatment but are not strokes or heart attacks. St Georges A&E at Tooting is already at full capacity and it relies on St Helier as a place to send ambulances when they cannot cope.
There have been promises of more money spent to increase capacity at St Georges but this seems to be at odds with the plan to save money and anyone who has been to that hospital can see that space is tight and parking is already a nightmare. What are they going to do? Knock down nearby houses? Another PFI project perhaps?
Also, the bureaucrats' obsession with providing consultant-based care 24/7 as per the quality standards is absurd when there are not enough consultants in the UK or in training in the UK to meet this requirement. Therefore, we will need to spend money bringing in doctors from other countries as well as more investment in training medical students in the unpopular specialty of A&E to meet this standard but that also flies in the face of the drive to cut costs.Georgia Lewis

We must not let the £360m figure distract us- they have billions to spend and are simply dangling that number to make a false case for cuts and reduction in essential services. Still no word from Tom Brake, who has been tweeting self-congratulatory nonsense this morning...

We must not let the £360m figure distract us- they have billions to spend and are simply dangling that number to make a false case for cuts and reduction in essential services. Still no word from Tom Brake, who has been tweeting self-congratulatory nonsense this morning...Niki R

Forty_two wrote:
So, will our brave Members of Parliament ride to the rescue and issue a statement on all of this today?

Where are you Mr Brake and Mr Burstow?

Dont forget they both voted for the legislation that paved the way for BSBV and also for Clause 119
Clowns the pair of them

[quote][p][bold]Forty_two[/bold] wrote:
So, will our brave Members of Parliament ride to the rescue and issue a statement on all of this today?
Where are you Mr Brake and Mr Burstow?[/p][/quote]Dont forget they both voted for the legislation that paved the way for BSBV and also for Clause 119
Clowns the pair of themLiberalsOut

Georgia - I've never understood the obsession with 'bureaucrats' tbh - the NHS clearly needs managers and most of the ones I have met are passionate about the health service. But the quality standards were designed and are pushed by doctors, based on standards set by the Royal Colleges. Surely if we don't have enough consultants to deliver minimum safety standards, we should have a rethink? I certainly wouldn't want my partner giving birth or my relative given emergency surgery without a consultant being there. All these exact same arguments were used about stroke and cardio and they were wrong. Yes A&Es see urgent care cases, but they aren't supposed to, they should be seen in an urgent care centre. But I do agree that if one hospital were to not provide A&E, the others would need to see more cases. i thought that was the whole point actually.

As for the £360 million, my reading was that that is the money the hospitals have earmarked to save so they don't go bust, not hing to do with CCG budgets. That seems quite a lot of money in a service that is already stretched and just suggests we need to structure the health services better, as with stroke etc.

Georgia - I've never understood the obsession with 'bureaucrats' tbh - the NHS clearly needs managers and most of the ones I have met are passionate about the health service. But the quality standards were designed and are pushed by doctors, based on standards set by the Royal Colleges. Surely if we don't have enough consultants to deliver minimum safety standards, we should have a rethink? I certainly wouldn't want my partner giving birth or my relative given emergency surgery without a consultant being there. All these exact same arguments were used about stroke and cardio and they were wrong. Yes A&Es see urgent care cases, but they aren't supposed to, they should be seen in an urgent care centre. But I do agree that if one hospital were to not provide A&E, the others would need to see more cases. i thought that was the whole point actually.
As for the £360 million, my reading was that that is the money the hospitals have earmarked to save so they don't go bust, not hing to do with CCG budgets. That seems quite a lot of money in a service that is already stretched and just suggests we need to structure the health services better, as with stroke etc.Danny Bhoy

On Tuesday 10th June at 19:30 at The Station Pub, Stoneleigh Broadway, Surrey, KT17 2JA.

Dr Simon Williams will be speaking about the future plans and priorities of Surrey Downs Clinical Commissioning Group (SDCCG) He will cover:

- What is the CCG and its responsibilities.
- What are the CCG vision, plans and priorities for healthcare in Surrey;
- integrated community and primary care
- care closer to home
- children's and maternity care based on latest guidance

I hope this talk will help inform residents of what is going on with healthcare in our area and the future developments.

Dr Simon Williams is a GP and member of the SDCCG governing board and is the lead for the Mid Surrey locality, which includes parts of Epsom and Ewell.
Clinical commissioning groups are statutory bodies; which have the function of commissioning services for the purposes of the health service in England.

Please come and support this event and bring your family and friends!

Free Talk on Local Health Care by Surrey Downs CCG.
On Tuesday 10th June at 19:30 at The Station Pub, Stoneleigh Broadway, Surrey, KT17 2JA.
Dr Simon Williams will be speaking about the future plans and priorities of Surrey Downs Clinical Commissioning Group (SDCCG) He will cover:
- What is the CCG and its responsibilities.
- What are the CCG vision, plans and priorities for healthcare in Surrey;
- integrated community and primary care
- care closer to home
- children's and maternity care based on latest guidance
I hope this talk will help inform residents of what is going on with healthcare in our area and the future developments.
Dr Simon Williams is a GP and member of the SDCCG governing board and is the lead for the Mid Surrey locality, which includes parts of Epsom and Ewell.
Clinical commissioning groups are statutory bodies; which have the function of commissioning services for the purposes of the health service in England.
Please come and support this event and bring your family and friends!mrsjanerace

The problem with Urgent Care Centres is that they are not required to be open 24/7.

The other problem with Urgent Care Centres is that they are being put out to tender so that private companies, motivated by profit, might run them and if they fail, the NHS will be left to pick up the pieces.

The problem with fewer A&E and maternity units is that people will spend longer travelling to them, whether in ambulances, public transport, taxis or private cars.

The problem with lack of consultant care is that the only real way to solve this is to bring in staff from overseas but this costs money.

And the CCGs are the ones who are making decisions about how money is spent and whether services need to be reconfigured. This seems, on the surface, to be a nice way to bring decision-making back to a local level but there lack of transparency is breathtaking. Right now, there is a CCG meeting going on at Merton Civic Centre and it is open to the public, but as it runs from 9am-12pm, it is hard for people who aren't either retired or unemployed to attend and ask challenging questions. Add to this the vested interests of many CCG members and a particularly farcical situation where CCG members walked out of a public meeting and completed the meeting in secret, and you have a system that is inherently dysfunctional.

The problem with Urgent Care Centres is that they are not required to be open 24/7.
The other problem with Urgent Care Centres is that they are being put out to tender so that private companies, motivated by profit, might run them and if they fail, the NHS will be left to pick up the pieces.
The problem with fewer A&E and maternity units is that people will spend longer travelling to them, whether in ambulances, public transport, taxis or private cars.
The problem with lack of consultant care is that the only real way to solve this is to bring in staff from overseas but this costs money.
And the CCGs are the ones who are making decisions about how money is spent and whether services need to be reconfigured. This seems, on the surface, to be a nice way to bring decision-making back to a local level but there lack of transparency is breathtaking. Right now, there is a CCG meeting going on at Merton Civic Centre and it is open to the public, but as it runs from 9am-12pm, it is hard for people who aren't either retired or unemployed to attend and ask challenging questions. Add to this the vested interests of many CCG members and a particularly farcical situation where CCG members walked out of a public meeting and completed the meeting in secret, and you have a system that is inherently dysfunctional.Georgia Lewis

Also it should be added that Urgent Care Centres were never originally intended to be standalone - they were always supposed to work alongside a conventional A&E, where proper triage would direct patients to the correct department depending on their needs.

Let's not even go into the reports about the Urgent Care Centre at Croydon University Hospital, run by Assura Wandle LLP (now called Virgin Care Wandle LLP) which has twice gotten into trouble for having staff who are not medically qualified triaging patients, and failing to refer people to A&E when they should have been doing so.

Let's also gloss over the number of CCG board members locally who have previously declared interests in Assura Wandle LLP.

Oh, and finally, let's not discuss the concept of a private health provider being set up as a Limited Liability Partnership (LLP).

Well said Georgia,
Also it should be added that Urgent Care Centres were never originally intended to be standalone - they were always supposed to work alongside a conventional A&E, where proper triage would direct patients to the correct department depending on their needs.
Let's not even go into the reports about the Urgent Care Centre at Croydon University Hospital, run by Assura Wandle LLP (now called Virgin Care Wandle LLP) which has twice gotten into trouble for having staff who are not medically qualified triaging patients, and failing to refer people to A&E when they should have been doing so.
Let's also gloss over the number of CCG board members locally who have previously declared interests in Assura Wandle LLP.
Oh, and finally, let's not discuss the concept of a private health provider being set up as a Limited Liability Partnership (LLP).Forty_two

And when it comes to quality standards, there are multiple standards kicking around now. As such, the bureaucrats can pick and choose the standards they deem hospitals to not be meeting, whether they are realistic or not, as grounds for cutting services. The goalposts keep moving.

And, ironically, if a hospital is not meeting standards, that should be a call for greater investment and improvement rather than closing down services.

And when it comes to quality standards, there are multiple standards kicking around now. As such, the bureaucrats can pick and choose the standards they deem hospitals to not be meeting, whether they are realistic or not, as grounds for cutting services. The goalposts keep moving.
And, ironically, if a hospital is not meeting standards, that should be a call for greater investment and improvement rather than closing down services.Georgia Lewis

There aren't multiple standards that every single London CCG has signed up to though. As I understand it, the hospitals are also all working towards the quality standards.

Some people seem to think these sorts of changes centralising services were invented by the current Tory-led government, but they started under Lord Darzi and Labour and in fact there were proposals on the table before the last election. The stroke , cardio and trauma changes have been an unqualified success. These are among the 3 worst things that can happen healthwise, yet people travel often much further now to be treated for them and loads more survive, because they go to a specialist unit. That's what I'd want for me or my family, not to take a chance on seeing an under-qualified medic because I was taken ill at the wrong time of day.

Also I think there have been stand-alone urgent care centres for years, the innovation recently has been to merge them with A&Es. I'd rather have an urgent care centre or an out of hours GP nearby than nothing, but I don't want a hospital full of junior doctors when I'm seriously ill. If one of us had a heart attack in Sutton today, we'd go to George's and we'd have a much better chance of living than we had before. I didn't support those changes at the time but I am happy to eat humble pie (in the hope it doesn't bring on a stroke!).

I honestly believe that the stroke and other changes have made the case against fewer, more specialist centres for some areas of medicine unanswerable and I just wish they'd get on with it.

There aren't multiple standards that every single London CCG has signed up to though. As I understand it, the hospitals are also all working towards the quality standards.
Some people seem to think these sorts of changes centralising services were invented by the current Tory-led government, but they started under Lord Darzi and Labour and in fact there were proposals on the table before the last election. The stroke , cardio and trauma changes have been an unqualified success. These are among the 3 worst things that can happen healthwise, yet people travel often much further now to be treated for them and loads more survive, because they go to a specialist unit. That's what I'd want for me or my family, not to take a chance on seeing an under-qualified medic because I was taken ill at the wrong time of day.
Also I think there have been stand-alone urgent care centres for years, the innovation recently has been to merge them with A&Es. I'd rather have an urgent care centre or an out of hours GP nearby than nothing, but I don't want a hospital full of junior doctors when I'm seriously ill. If one of us had a heart attack in Sutton today, we'd go to George's and we'd have a much better chance of living than we had before. I didn't support those changes at the time but I am happy to eat humble pie (in the hope it doesn't bring on a stroke!).
I honestly believe that the stroke and other changes have made the case against fewer, more specialist centres for some areas of medicine unanswerable and I just wish they'd get on with it.Danny Bhoy

I was referring to the confusion that has arisen because there are CQC standards which differ from London Quality Standards. Bureaucrats apply whichever one suits their agenda, usually whichever one is hardest to attain in order to justify closing hospital departments down.

Even with the specialist centres for cardiac, stroke and trauma cases, there is still a need for A&E at hospitals such as St Helier. The specialist centres are doing amazing things - nobody disagrees - but St Helier Hospital still has a busy A&E department as well as being the hospital where patients are sent when St Georges is at full capacity. St Helier's A&E is performing well, there is no greater risk of dying on a weekend there compared to a weekday and if it is shut down, along with maternity, there will be a gaping hole left in SW London healthcare.

It is indeed true that changes have been made to healthcare by successive governments (PFI was a terrible Labour government idea, for example). However, under the current government, the rate of contracts outsourced to private companies has gone through the roof (including Urgent Care Centres), the NHS has actually become more rather than less bureaucratic and Clause 119, the result of Jeremy Hunt throwing his toys out of the pram over Lewisham Hospital, will make it easy for the government to close hospitals, even ones that are performing well.

I was referring to the confusion that has arisen because there are CQC standards which differ from London Quality Standards. Bureaucrats apply whichever one suits their agenda, usually whichever one is hardest to attain in order to justify closing hospital departments down.
Even with the specialist centres for cardiac, stroke and trauma cases, there is still a need for A&E at hospitals such as St Helier. The specialist centres are doing amazing things - nobody disagrees - but St Helier Hospital still has a busy A&E department as well as being the hospital where patients are sent when St Georges is at full capacity. St Helier's A&E is performing well, there is no greater risk of dying on a weekend there compared to a weekday and if it is shut down, along with maternity, there will be a gaping hole left in SW London healthcare.
It is indeed true that changes have been made to healthcare by successive governments (PFI was a terrible Labour government idea, for example). However, under the current government, the rate of contracts outsourced to private companies has gone through the roof (including Urgent Care Centres), the NHS has actually become more rather than less bureaucratic and Clause 119, the result of Jeremy Hunt throwing his toys out of the pram over Lewisham Hospital, will make it easy for the government to close hospitals, even ones that are performing well.Georgia Lewis

Danny Bhoy - on the issue of stroke care, I understand one such 'Stroke super-centre' hospital is Charing Cross - which is due to be demolished and flats built on the site. Think about that for a minute.

Also, the argument for fewer sites offering "centre of excellence" status doesn't stack up for all conditions, ailments and needs.

You seem to have been entirely convinced by the mantra of BSBV and now SWLCCG - do you work for them, or one of the local CCGs by any chance?

Danny Bhoy - on the issue of stroke care, I understand one such 'Stroke super-centre' hospital is Charing Cross - which is due to be demolished and flats built on the site. Think about that for a minute.
Also, the argument for fewer sites offering "centre of excellence" status doesn't stack up for all conditions, ailments and needs.
You seem to have been entirely convinced by the mantra of BSBV and now SWLCCG - do you work for them, or one of the local CCGs by any chance?Forty_two

No I don't work for the NHS! And wow. Do you think everyone who supportschange is in the pay of the local CCGs? Loads of national bodies have been advocating these kind of reforms for some time. All you have to do is read the evidence and look at the successes of previous change in London.

The bottom line is this. If I need emergency treatment, or if my partner is having a baby, I want a consultant delivering the care, not a trainee.

No I don't work for the NHS! And wow. Do you think everyone who supportschange is in the pay of the local CCGs? Loads of national bodies have been advocating these kind of reforms for some time. All you have to do is read the evidence and look at the successes of previous change in London.
The bottom line is this. If I need emergency treatment, or if my partner is having a baby, I want a consultant delivering the care, not a trainee.Danny Bhoy

Danny Bhoy - sorry, but I think you and I will have to agree to disagree about this.

Your "bottom line" argument is flawed. The previous proposal put forward by BSBV was that we should have "midwife led" maternity units with no consultants present at all. The plan being that if an expectant mother was "at risk" she'd be sent to a conventional maternity unit, but "low risk" births could be directed to the midwife led units - there are two fundamental problems here:
1. Births can very quickly change from low risk to high risk.
2. When the midwife led units then fail (either due to lack of use, or when people start losing their lives), they will be closed leaving only a handful of conventional maternity units who will be unable to cope with the demand.

Sometimes with these things we need to think about:
a) Why people might be telling you what they're telling you
b) Whether there is a hidden agenda
c) Let's not just accept at face value what we're told, especially when there are obvious contradictions

Danny Bhoy - sorry, but I think you and I will have to agree to disagree about this.
Your "bottom line" argument is flawed. The previous proposal put forward by BSBV was that we should have "midwife led" maternity units with no consultants present at all. The plan being that if an expectant mother was "at risk" she'd be sent to a conventional maternity unit, but "low risk" births could be directed to the midwife led units - there are two fundamental problems here:
1. Births can very quickly change from low risk to high risk.
2. When the midwife led units then fail (either due to lack of use, or when people start losing their lives), they will be closed leaving only a handful of conventional maternity units who will be unable to cope with the demand.
Sometimes with these things we need to think about:
a) Why people might be telling you what they're telling you
b) Whether there is a hidden agenda
c) Let's not just accept at face value what we're told, especially when there are obvious contradictionsForty_two

**** right, Forty_Two. Also, the current focus on supporting home birth is interesting. While home birth is a perfectly valid choice for women and one that should be supported, it should not be at the expense of proper, accessible maternity services. As soon as government and bureaucrats start singing the praises of home birth, it is vital to question whether their motivations are altruistic or financial...

**** right, Forty_Two. Also, the current focus on supporting home birth is interesting. While home birth is a perfectly valid choice for women and one that should be supported, it should not be at the expense of proper, accessible maternity services. As soon as government and bureaucrats start singing the praises of home birth, it is vital to question whether their motivations are altruistic or financial...Georgia Lewis